1. Chronic Fatigue Syndrome and Fibromyalgia 2009 “State of the Union” May 12, 2009 Jacob Teitelbaum MD

2. Approximately 6 - 12 million Americans(2-4-%) have severe Chronic Fatigue Syndrome (CFS) and/or Fibromyalgia (FMS) and another 6-12 million have a less severe form (intermediate Fibromyalgia) Only 15% of these have been given the correct diagnosis Prevalence has more than DOUBLED in the last 10 years! Statistics

3. Our “Gold-Standard” Research Shows: Most people with pain and/or CFS/FMS can reclaim their vitality and be PAIN FREE!

4. Tired Achy Brain fog Can’t sleep? Think CFS and Fibromyalgia which are now very treatable! Even Very Severely Ill People

5. CFS/FM represent a mix of many different processes with a common endpoint Each problem may trigger other problems Like “blowing a fuse”, these syndromes reflect an energy crisis in your body, and can be triggered by anything that causes severe stress or prevents energy production Pathophysiology of CFS/FM

6. Causes of CFS & Fibromyalgia When ENERGY DEMAND is greater than ENERGY SUPPLY Multiple causes and subsets—not the same disease from person to person

7. Hypothalamus This circuit controls: –Sleep –Hormonal function –Temperature –Autonomic function (B/P, pulse, sweats, etc.) It requires an enormous amount of energy to do all this- which is why it acts as a circuit breaker - protecting the person from further injury

8. Pain Your muscles also need a lot of energy When you run out, they get stuck in the shortened, rigid position and hurt – including by the joints where they attach (think about rigor mortis). Chronic pain results in increased brain sensitivity to pain (Central Sensitization)

9. Why You “Blew Your Fuse” Sudden Onset – think: –Viral, parasitic or antibiotic sensitive infections –Injury –pregnancy Gradual Onset – think: –Hormonal or nutritional deficiencies –Yeast/Candida infections –Auto-immune diseases –Sleep disorders –Severe stress

10. Causes &Triggers-Current research May be caused by over a dozen different infections Multiple hormonal deficiencies (hypothalamic/pituitary) Excessive stress Sleep disorders Nutritional deficiencies Multiple neurotransmitter and cytokine abnormalities

11. Earlier research examined the efficacy of an integrated treatment plan for the treatment of CFS/FMS compared to placebo. 91 percent of the CFS and fibromyalgia patients receiving active treatment experienced moderate to marked improvement in their symptoms of pain and fatigue compared to the placebo group. Effective Treatment Of Chronic Fatigue Syndrome (CFIDS) & Fibromyalgia (FMS) - A Randomized, Double-Blind, Placebo- Controlled, Intent To Treat Study. Journal Of Chronic Fatigue Syndrome Volume 8, Issue 2 - 2001 Clinical Research

12. Study Design Randomized Double-Blind Placebo-Controlled Intent to Treat Analysis

13. Results (p<.0001) Much Better BetterSameWorse Much Worse Active 1613201 Placebo 391163

14. Average Analog Score per group by visit number 1. (p=.95) 2. (p=.0051) 3. (p=.0063) 4. (p=.0053) Final (p=.0002) (*p<.0001 adjusted for baseline score) Well Being (Analog) Index Score Average (By Group) – Per Visit

15. Long Term Effectiveness A 2-year follow up showed that patients continued to improve despite being able to wean off most treatments They went from an average ~ 75% improvement in quality of life at 99 days to an average ~90% increase

16. New Research Data Follow up of ~ 15,000 CFS/Fibromyalgia patients treated at the Fibromyalgia and Fatigue Centers clinics is being readied for publication ~85% of patients using the “SHINE Protocol” improved. “SHINE” restores both energy production and hypothalamic function—while markedly decreasing or eliminating pain

17. I had CFS/FMS in 1975 Since then, I’ve dedicated myself to creating effective treatment for everyone

18. You “blew a fuse” (the hypothalamus)! To turn it back on and make your fatigue and pain go away, 5 main areas need to be treated…

19. Sleep Hormonal deficiencies Infections Nutritional deficiencies Exercise as able Think “SHINE”

20. Avoid Writer’s Cramp www.Vitality101.com Do the Free Online Program to tailor a treatment protocol to your case (and sign up for a free e-mail newsletter to keep you up to date)

21. Good Quality Sleep

22. To eliminate pain and restore energy production, it is critical to get eight to nine hours of deep sleep each night. However, because of sleep center malfunction and pain, patients with CFS/FMS do not stay in deep stages of sleep. Getting A Good Night’s Sleep

23. Disordered Sleep in CFS & Fibromyalgia Studies have demonstrated that CFS/FMS patients are at risk for many sleep disorders (in addition to severe insomnia): Restless Leg Syndrome—Treating the iron deficiency may be more effective than Requip Sleep apnea UARS- Upper Airway Resistance Syndrome

24. Passionflower and Wild lettuce help to calm and induce and maintain sleep Jamaican dogwood promotes muscle relaxation Valerian and Hops - shown in clinical studies to both help people fall asleep AND stay asleep L-theanine (an amino acid found in green tea) helps create a relaxed feeling, and also has muscle relaxing properties – while inducing deep sleep These herbs help the body relax and move through all sleep stages - wake up calm and refreshed instead of groggy and tired Healthy Sleep: Natural Support

25. Contains all 6 of these herbs The BEST natural sleep aid available Take 1 – 4 caps as needed (1 hour before bed time) Excellent for anyone with insomnia, muscle pain and anxiety (even during the day) Revitalizing Sleep Formula

26. Some Prescription Sleep Aids Ambien Desyrel Klonopin Neurontin Lyrica Doxepin

27. HORMONES Your body’s communication and control system

28. Hormones are produced by glands,which are controlled by the hypothalamus. Multiple studies are showing Hypothalamic-Pituitary axis dysfunction Thyroid – your body’s gas pedal Adrenal (cortisol & DHEA) – the stress handler Ovaries (estrogens and progesterone) and testes (testosterone) Hormone Production

29. Even mild under-production of hormones (deficiency) can be associated with many health problems, and leave you sick, tired, “brain-fogged” and in pain! Hormonal deficiencies are common – despite normal blood tests Treat with natural hormones Hormonal Deficiencies

30. Thyroid (the body’s gas pedal) Symptoms of low thyroid include: –Fatigue –Weight gain –Joint/muscle pain (aches) –Cold intolerance –Thinning of lateral eyebrows –Poor memory and depression Treat – Compounded or Armour Thyroid (Rx) and nutritional support Low Thyroid Hormone

31. Weight Gain The average weight gain in CFS is 32 pounds (in 2 studies in our research center)! Can help promote weight loss by: Addressing thyroid and adrenal hormone deficiency Taking acetyl-l-carnitine 1000 mg/day Treating fungal overgrowth Getting 8 hours sleep a night

32. Too much time spent in a state of high stress can exhaust the adrenal gland. New research suggests “Adrenaline Overdrive” and exhaustion Adrenal exhaustion is common and not recognized yet by traditional medicine Symptoms: low blood pressure hypoglycemia crashing with stress Adrenal Burnout

33. Glandular adrenal extract contains supportive nutrients Vitamin C and pantothenic acid (Vitamin B5) are critical to support adrenal gland function Licorice - supports cortisol and acts as an antiviral Also consider: DHEA if level is low and natural cortisol (cortef) in ultra low dosing Natural Support of the Adrenal Gland ADRENAL STRESS-END

34. Infections Most important is yeast/fungal overgrowth Suspect in all CFS/FMS patients. Markers include sinusitis and spastic colon Rx – Acidophilus Pearls, low sugar (use stevia), antifungals (e.g.-Anti-yeast), Diflucan (Rx) New research shows both increase in bowel yeast during flares of CFS and clinical improvement with probiotics

35. Chronic Infections in CFS/FM Dozens of Chronic Infections in CFS documented (several new ones this year) –Viral –Antibiotic sensitive –Yeast (Candida and others) –Parasites Shows that the immune suppression is primary, with the body picking up many infectious “hitch hikers”.

36. Nutritional Deficiencies-New Research Research showing multiple Amino Acid (protein) deficiencies Low tyrosine-Can contribute to low dopamine, adrenaline and thyroid. May be caused by autonomic dysfunction with adrenaline/sympathetic nervous system overdrive Multiple other amino acid deficiencies are also critical to treat (for glutathione, neurotransmitters, etc)

37. Nutritional Deficiencies-New Research Multiple nutritional deficiencies are likely Which vitamin/mineral do you need? ALL OF THEM! New research shows: Vitamin D Deficiency (controversial) Iron helpful for RLS (Restless Legs) Iodine deficiency recurring in the USA

38. 1 good tasting drink and 1 capsule Replaces 35 supplement tablets a day! Contains 50 key nutrients! Supplies optimal nutritional support for everyone easily and affordably 100% of my royalties go to charity as a teacher, to avoid a conflict of interest, I refuse to take money from any company whose products I recommend The Energy Revitalization System Makes It Easy

39. Mitochondrial and Genetic Research 2 new studies documented defects in genetic energy production Multiple studies showed a host of genetic predispositions to CFS. Polymorphisms were found to correlate with gene expression and were strong predictors of CFS

40. D-Ribose-CORvalen This is an incredibly promising new nutrient for pain and fatigue patients Ribose availability is a rate limiting issue in energy production-especially in people having an energy crisis I consider it to be the most important nutritional discovery of the decade!

41. D-Ribose-CORvalen ATP is composed of Ribose, adenine and phosphate groups FAD is ribose plus riboflavin and adenine Acetyl CoA is ribose plus pantothenic acid and adenine DNA and RNA have ribose as a key component Ribose deficiency in energy deficient states can be a critical piece of the puzzle

42. CORvalen Study 36 CFS/Fibromyalgia patients 65.7% improved significantly(~20% dramatically) Significant improvements were found in: –energy levels (+45%), –sleep patterns (+25%), –mental clarity (+16%), –pain (-14%), and the –patient’s overall state of well being (+30%)

43. Mind Body Connection There is no longer a question whether CFS is real and physical. It clearly is. All illnesses (e.g..-cancer, MS, heart attacks) have a psychodynamic As with any illness, counseling should be used to support the patient if needed— not to invalidate the illness Cognitive Behavioral Therapy (CBT) not effective by itself (75% drop out rate— more patients got worse than improved)

44. 3 new medications approved by FDA for Fibromyalgia pain (Lyrica, Cymbalta, and Savella) Though helpful, best to also treat the underlying causes of the pain with “SHINE” Medications

45. From Fatigued To Fantastic! The best-selling book on effective CFS/Fibromyalgia therapies It can teach you how to get your life back!

46. “Teitelbaum’s treatment approach is an excellent and highly effective part of the standard of practice for treating Fibromyalgia and MPS” Editorial in the journal of the American Academy of Pain Management CFS & Fibromyalgia are treatable! CFS & Fibromyalgia are treatable! Remember SHINE!

47. Getting Well Now Do the free patented online program at www.Vitality101.com It will analyze your symptoms (and labs if available), determine the underlying causes of your CFS & Fibromyalgia, and tailor a treatment protocol to your case

48. Fibromyalgia and Fatigue Centers Physicians throughout the US who know how to effectively treat CFS & Fibromyalgia. New-International program now available www.FibroAndFatigue.com

49. Finally…. Chronic Fatigue Syndrome Pain And Fibromyalgia Are Now Treatable!